Duffy, Sharon 333
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sharon L. Duffy Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 4,2013 66 War or Dates Vietnam
Place of Death Hospital, Institution or
IZ City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Suzanne M.Blood
Address
14 Manor Drive,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 ay 0
❑Burial Date Cemetery or Crematory
❑Entombment June 6,2013 Pine View Crematory
Address
El Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
F_ Hold
N
O Date Point of
u) Transportation Shipment
p by Common Destination
Carrier
1 Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
I_ Remains are Shipped, If Other than Above
2 Address
a
Permission is hereby granted to dispose of the human remains described above as indicated.
h
Date Issued / 60 3 Registrar of Vital Statistics GO CAM--.52.Vk)
ignature)
District Number 5601 Place Glens Falls1 W
I certify that the remains of the decedent identified above were disposed ofof in accordance with this permit on:
"1 C
Date of Disposition (0,11113 Place of Disposition � yt�J ftir••
(address)
W
N
(section) Licre.nber)
S vl' (grave number)
p Name of Sexton or Pers n in Charge o PremisesehWse print)
Signature 1)(1- Title 6E01I'rOR
(over)
DOH-1555 (02/2004)